The combined cheek and neck lift reflects a modern understanding of facial anatomy. Individually reposition and sculpt sagging facial tissue to make patients appear like younger, rested versions of themselves.

The supporting tissue of the face is called SMAS and is in continuity with the neck muscle called platysma. As we age, we lose volume in our face, while the connective tissue of the skin and SMAS weakens. Facial tissues tend to sag over the jaw line, producing unwanted jowls, wrinkles, and folds. Similarly, these mechanisms cause excess skin and banding on the neck as the underlying muscle is unable to retain its youthful contour.

In an operation to restore facial appearance to its youthful version, attention should be paid not only to the skin, but particularly to the volume under it. Pulling the skin gives only an incomplete and temporary result. Sculpting is the repositioning of the underlying skin tissues that provides the appearance of an optimal facelift.

As the Platysma muscle ages and its supporting structure weakens, it can form bands on the neck. As part of the facelift, the platysma muscle is tightened under the jaw and laterally in the neck, effectively providing a corset to reshape this area. In some patients, liposuction removes fat from the jowls to further contour this area.

As we age, the youthful fatty tissue found over the cheekbone area droops. This tissue is called malar fat. The bright, youthful appearance of our cheeks is diminished as there is less volume above the apex of the cheekbones, and the sagging of malar fat can produce unwanted cheek shadows under the eyes. Volume loss also affects the fat in the lower part of the face, called the buccal region. This produces a hollower appearance, which is also a sign of aging. As midface volume loss progresses, the skin that used to smoothly cover the youthful face sags and worsens the shadow of the nasolabial fold.

The nasolabial fold is the border between the cheek, the nose and the lip. It is identified on the face as a deep line between the cheeks and the lips. The worsening occurs due to the loss of volume and elasticity in the cheek, and the flaccidity and fall of this tissue, forming a fold.

A new-onset nasolabial fold can be treated with hyaluronic acid injectables and produce a youthful or even natural appearance. Nasolabial folds seem to get worse as we age because the cheek droops downward as we age, causing a worsening of the shadow in the fold. The solution to this problem is not to fill the area under the fallen tissue with hyaluronic acid, but to lift the cheek to its normal position.

The cheek lift reverses the signs of aging by suspending the area in its correct position, through well-concealed and limited incisions. Malar fat is repositioned to provide the beautiful contour we see on every magazine cover. The buccal tissue is further lifted, which reduces excess and laxity of the skin over the nasolabial fold and thus reduces the shadow of the nasolabial fold.